Rivaroxaban may offer benefit in many clinical situations. In comparison with low molecular weight heparin and fondaparinux requiring subcutaneous way of administration, and with vitamin K antagonists (VKAs), which require regular monitoring of international normalized ratio, rivaroxaban is relatively easy to use. However, adjustments of dose are needed in individuals with impaired renal functions.
The aim of this study was to evaluate the safety of irreversible electroporation (ire) and the outcome of patients undergoing ire of locally advanced pancreatic cancer (Pc). twenty-one patients with unresectable Pc underwent open (n=19) or percutaneous (n=2) ire of the tumor using the Nanoknife system with two electrodes that were repositioned several times to affect the whole mass. The size of the tumor was 39±10mm with a range from 21 to 65mm. Five patients underwent neoadjuvant chemotherapy and seven patients were treated with chemotherapy after ire. complications occurred in five patients, which resulted in prolongation of the average hospital stay from 10 to 34 days. There was no mortality in the first postoperative month. median survival after ire was 10.2 months compared to 9.3 months in a matched cohort (hazard ratio = .54, p = .053). The quality of life was declining slowly. 81% of time after ire the Karnofsky performance status was ≥70 and sharp decline occurred approximately 8 weeks before death.in conclusion, ire is a safe palliative treatment option for a percentage of patients with locally advanced pancreatic carcinoma. The patients treated with open ire lived a decent life until 8 weeks before their death. We believe that ire of pancreatic carcinoma can be regarded as an option, if imaging or explorative laparotomy show that r0 resection in not possible.
The purpose of this prospective study was to determine whether the cost and cost-effectiveness of early rehabilitation after stroke are associated with the degree of initial disability. The data for cost calculations were collected by the bottom-up (micro-costing) method alongside the standard inpatient care. The total sample included 87 patients who were transferred from acute care to early rehabilitation unit of three participating stroke centers at the median time poststroke of 11 days (range 4–69 days). The study was pragmatic so that all hospitals followed their standard therapeutic procedures. For each patient, the staff recorded each procedure and the associated time over the hospital stay. The cost and cost-effectiveness were compared between four disability categories. The average cost of the entire hospitalization was CZK 114 489 (EUR 4348) with the daily average of CZK 5103 (EUR 194). The cost was 2.4 times higher for the immobile category (CZK/EU: 167 530/6363) than the self-sufficient category (CZK/EUR: 68 825/2614), and the main driver of the increase was the cost of nursing. The motor status had a much greater influence than cognitive status. We conclude that the cost and cost-effectiveness of early rehabilitation after stroke are positively associated with the degree of the motor but not cognitive disability. To justify the cost of rehabilitation and monitor its effectiveness, it is recommended to systematically record the elements of care provided and perform functional assessments on admission and discharge.
Background. Despite the high volume of contrast-enhanced computed tomography (CECT) examinations, there is limited awareness about its risks among patients and little is known about the influence of patient information sheets. Objectives. The objective of this study was to assess patients' awareness and perception of risks related to CECT examination and how they are influenced by an information sheet. Material and methods. A total of 263 adult patients scheduled for a CECT examination completed a questionnaire. The first page evaluated patients' characteristics, their fear and awareness about examinationrelated risks, and source of information. Page 2 contained the Zung self-rating anxiety scale. After reading the information sheet, patients completed page 3 that surveyed how their awareness and fear had changed. Results. Nearly half of the patients underestimated the risk of secondary malignancy (n = 121, 46%), or the risk of renal impairment (n = 110, 42%). The vast majority (n = 227, 86%) stated that they were not instructed to maintain fluid intake up to 1 h before the procedure. After reading the information sheet, patients generally corrected their knowledge, but 195 (74%) reported experiencing greater fear (p < 0.0001). Fear was more pronounced in younger female patients who had not undergone CT previously. Patients feared the result more than examination-related risks. Most patients (n = 204, 78%) would feel uncomfortable before receiving the examination result. Conclusions. Most patients do not assess risks related to CECT examination correctly. Although the information sheet improves patients' understanding of CECT-related risks, it lacks empathically delivered reassurance and increases their fear. Fast communication of examination results would make patients feel more comfortable.
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